Spinal cord injury

　　Spinal cord injuries often occur in industrial and mining accidents, traffic accidents, during wartime, and natural disasters, and can occur in batches. The condition is serious and complex, with multiple injuries and complex injuries, many complications, and poor prognosis when combined with spinal cord injury, even causing lifelong disability or endangering life.

　　The causes of spinal cord injury mainly involve two aspects of factors.

　　1) Open injury:It is more common during wartime, often accompanied by spinal injuries, mainly seen in gunshot wounds, knife stabs, explosive injuries causing blade injuries, blows, and collisions directly acting on the spine, causing fractures or dislocations, and further damaging the spinal cord. The injury is consistent with the site of external force, and the degree of injury is proportional to the size of the external force. It can occur at any part of the spinal cord, with the thoracic cord being the most common.

　　2) Closed injury:It is more common in peacetime, mainly seen in traffic accidents, falls, sports injuries, spinal twists, overloading, etc., causing excessive extension, flexion, and torsion of the spine, resulting in spinal fractures, dislocations, injuries to the spinal accessories, or injuries to the ligaments and blood supply vessels of the spinal cord, thereby causing closed injuries.

　　Patients with acute spinal cord injury will be affected by each system. Atrophy and accumulation of respiratory secretions often lead to pneumonia and other respiratory complications, while venous thrombosis in the cardiovascular system often results in deep vein thrombosis. Literature reports that 3% to 13% of cases of deep vein thrombosis lead to phlebitis or fatal pulmonary embolism. Pressure on the area without sensation can cause bedsores and ulcers. Inability to move limbs can lead to muscle atrophy and severe contractures of the soft tissues around the joints. The accumulation in the urinary tract system can cause frequent infections and calcification. Inactivity of the skeletal system causes a large loss of calcium, leading to urinary tract stones, ectopic bones, severe osteoporosis, and ultimately pathological fractures. Gastrointestinal paralysis can cause intestinal obstruction, ulcers, bleeding, and chronic constipation, and sometimes can be complicated by pancreatitis.

　　For patients over 40 years of age with acute spinal cord injury who have arrhythmias due to neurogenic shock, a history of heart disease, or direct heart injury, close heart rate monitoring should be provided. For younger patients in good general condition, a multi-lumen central venous pressure catheter and peripheral venous access should be provided, and continuous electrocardiogram monitoring can greatly reduce cardiovascular complications.

　　The most common complication of acute spinal cord injury is still the involvement of the respiratory system, which can lead to changes in lung function due to the paralysis of the intercostal muscles. Direct外伤to the ribs and lung parenchyma can occur in patients with multiple trauma. High-level quadriplegic patients are often given prophylactic tracheal intubation, and oxygen should be administered when arterial oxygen levels are insufficient or respiratory distress occurs. Chest physical therapy should be performed every 4 hours, and oxygen masks, nasal cannulas, or end-expiratory positive pressure masks can be used as needed to maintain blood gas levels within the normal range; tracheal intubation should be performed as much as possible through the nose to avoid tracheotomy.

　　In patients with quadriplegia due to C1-4 injury, if there is no spontaneous respiration, early tracheotomy should be performed, and chronic airway support, intermittent ultrasound examination, diaphragm and phrenic nerve electrophysiological examination should be done well. In addition, vital capacity, tidal volume, and other respiratory parameters should be closely monitored. Patients with acute spinal cord injury, especially those with quadriplegia, may experience mucus obstruction, atelectasis, and even respiratory distress if the tracheal tube is removed too early.

　　Acute gastrointestinal bleeding in patients with acute spinal cord injury is often fatal, so hydrogen ion antagonists should be administered intravenously, a gastric tube should be placed, and gastric secretions should be maintained at low pressure drainage, with pH testing every 4 hours. Patients with acute spinal cord injury at the cervical level often have neurogenic shock, and these patients often manifest as a sympathectomy-like syndrome, such as increased gastric acid secretion, relative ischemia of the gastrointestinal tract, and weakness, which are easy to cause stress ulcers.

　　In addition to cardiovascular and pulmonary complications, another main cause of death in patients with acute spinal cord injury is urinary tract infection accompanied by sepsis. The management of the genitourinary system starts in the emergency room, with the insertion of a Foley catheter, urine output monitoring, and attention to gross and microscopic hematuria. Patients with catheters should undergo urine bacterial culture once every 4 days because there may be an asymptomatic urinary tract infection.

　　Almost all acute spinal cord injury patients have detectable bacteria in their paralytic bladders. In addition, there are many invasive catheters in the ICU, such as intravenous catheters, arterial catheters, even heart catheters and craniocervical traction clamps, all of which have a high risk of concurrent sepsis. Therefore, all diagnostic and treatment measures should be carried out under strict sterile conditions, and relevant nursing protocols should be followed.

　　Spinal cord injury is mostly caused by falling from a height, with the buttocks or feet landing, and the impact force transmitted upwards to the thoracolumbar segment to cause fracture. A small number are caused by direct external force, such as collapsed house injury, car collision injury, or firearm injury. Thoracolumbar spine fractures are common, and spinal fractures can be accompanied by injury to the spinal cord or cauda equina, especially in cervical fractures, where dislocation and spinal cord injury may occur, and according to reports, the highest incidence may reach 70%, which can cause severe disability or even loss of life.

　　The main manifestations of spinal cord injury are:

　　(I) Spinal fracture

　　The patient feels local pain at the injury site, cervical movement disorder, lumbar and back muscle spasm, unable to roll over and stand up, the local fracture may have limited posterior bulging deformity. Due to the stimulation of retroperitoneal hematoma on the autonomic nerves, intestinal peristalsis slows down, abdominal distension and abdominal pain may occur, and sometimes it needs to be distinguished from abdominal organ injury.

　　(II) Combined spinal cord and nerve root injury

　　After spinal cord injury, motor, sensory, reflex, sphincter, and autonomic nerve function below the level of injury are all damaged.

　　For patients with spinal cord injury, X-ray examination can basically determine the location and type of fracture, CT examination is conducive to determining the degree of displacement of the fractured block and the invasion of the spinal canal, and the detection of bone fragments or intervertebral discs protruding into the spinal canal. Magnetic resonance imaging: extremely valuable for determining the condition of spinal cord injury.

　　When first aid and transportation are needed for patients with spinal cord and spinal injury, do not use soft stretchers, but use boards for transportation. First, extend the lower limbs of the injured person straight, and place the two upper limbs straight next to the body. Place the board on one side of the injured person, and have 2-3 people support the trunk, pelvis, and limbs of the injured person to form a whole and roll it onto the board. Do not use methods such as embracing, lifting the head, or lifting the legs. For patients with cervical spine injury, support the head and slightly pull it along the longitudinal axis, rolling it in unison with the trunk. Pad the soft material between the injured person's body and the board to fix it. During transportation, observe whether the respiratory tract is blocked and remove it in time, and check the changes in breathing, heart rate, and blood pressure.

　　Spinal cord injury is a common disease, with middle-aged and elderly people as the high-risk group. It brings great harm to patients' bodies and seriously ruins patients' physical and mental health. Therefore, preventive measures for spinal cord injury are indispensable. So, how to effectively prevent spinal cord injury? Below, let's learn about effective preventive programs for spinal cord injury together.

　　First, pay attention to regulating one's mood in daily life and maintaining a cheerful mood.

　　Second, pay attention to nutrition. The diet for spinal cord diseases should be rich in protein and vitamins, ensuring the intake of sufficient carbohydrates and trace elements.

　　Third, patients with muscle atrophy affecting daily activities should use protective and assistive devices early to prevent injury and maintain an appropriate amount of activity, and perform some massage.

　　Fourth, early-stage patients with spinal cord diseases should persist in their work, engage in simple exercises, but should avoid excessive activities, high-intensity exercises, and overly active physical therapy to avoid exacerbating the condition.

　　Fifth, if the medullary muscles are involved, those with slight difficulty in swallowing should eat semi-solid foods to avoid coughing.

　　How to effectively prevent spinal cord injury? Believe it or not, experts say: To do a good job in preventing spinal cord injury, reduce the incidence of the disease. If you accidentally suffer from spinal cord injury, be sure to seek treatment early to avoid delaying the patient's condition.

What are the five major examinations for spinal cord injury? Spinal cord injury is one of the serious diseases that harm people's physical health. More knowledge about the disease is helpful for prevention and treatment. So, what are the examination methods for spinal cord injury? Below, let's specifically understand the five major examinations for spinal cord injury.

　　Five Major Examinations for Spinal Cord Injury

　　1, X-ray examination

　　Routine radiography of the spine in anteroposterior and lateral positions, and oblique positions if necessary. When interpreting the films, measure the height of the anterior and posterior parts of the vertebral bodies and compare them with the upper and lower adjacent vertebrae; measure the interpedicular distance and the width of the vertebral bodies; measure the distance between the spinous processes and the width of the intervertebral disc space, and compare them with the upper and lower adjacent intervertebral spaces. Measure the height of the interpedicular process in anteroposterior and lateral positions. X-rays can basically determine the location and type of the fracture.

　　2, CT examination

　　It is conducive to determining the degree of invasion of the displaced bone fragments into the spinal canal and to discovering bone fragments or intervertebral discs that protrude into the spinal canal.

　　3, MRI (Magnetic Resonance Imaging) examination

　　It is of great value in determining the condition of spinal cord injury. MRI can show early edema and hemorrhage in spinal cord injury, and can also show various pathological changes of spinal cord injury, such as compression of the spinal cord, complete spinal cord transection, incomplete spinal cord injury, atrophy of the spinal cord, or cystic change.

　　4, SEP (Somatosensory Evoked Potentials)

　　It is a method of detecting the conduction function of the somatosensory system (mainly the posterior column of the spinal cord). It is helpful to determine the degree of spinal cord injury. Now there is MEP (motor evoked potential).

　　5. Jugular venous compression test and myelography

　　The jugular venous compression test has certain reference significance for determining the injury and compression of the spinal cord. Myelography is of significance for the diagnosis of old traumatic spinal canal stenosis.

　　The above are the five major examinations introduced by our experts for everyone, hoping it can help everyone's health. For the sake of our health, everyone should learn more about the knowledge of diseases.

　　Spinal cord injury has a serious impact on the patients' ability to live and take care of themselves, causing great harm to their psychology and health. For patients with spinal cord injury, in addition to receiving reasonable treatment, attention should also be paid to the dietary adjustment of patients with spinal cord injury.

　　Attention should be paid to the diversity of food types consumed every day for the diet of spinal cord injury, not to be picky and eat more high-fiber foods; do not eat too much fat and sugar, especially for patients with obesity; eat more vegetables and fruits. It is necessary to drink enough water of 3000 milliliters per day, which is helpful for bladder emptying at regular intervals, maintaining cleanliness, and preventing urinary tract infections, as well as softening feces. The diet of spinal cord injury needs to pay attention to: the water quality must be clean. If it is not clean, it should be boiled for 20 minutes, cooled, and then drunk.

　　Fruits, vegetables, beans, brown rice, and whole wheat all contain abundant fiber. Eating more of these foods makes feces soft and easy to excrete, reducing the need for soft stool. It is also necessary to know that high-fiber foods for spinal cord injury must be paired with 3000 milliliters of water per day to effectively meet the requirements of healthy diet. Appropriate amounts of tea, coffee, or juice can be consumed as an alternative to some water. Milk provides protein and various vitamins and minerals, which is also very important.

　　Do not drink more than 600 milliliters a day. Drinking too much milk can cause kidney problems, which is also a point that needs to be paid attention to in the diet of spinal cord injury. Do not drink too much alcohol, as alcohol can cause many serious problems for patients with spinal cord injury. Drinking too much alcohol will increase the frequency of urination, so it is very likely to wet clothes or beds, and may also forget to relieve stress, leading to bedsores or causing insufficient stability during turning or using wheelchairs, resulting in falls and injuries.

　　In addition to the dietary adjustment for patients with spinal cord injury, attention should also be paid not to consume too many high-calorie foods, such as fatty meat, ice cream, carbohydrates, etc., increase the intake and amount of high-fiber foods, and pay attention to the supplement of fruits and vegetables.

　　The above is the explanation of the best dietary program for spinal cord injury, hoping it can help everyone.

　　Patients with spinal cord injury should actively rescue and protect the remaining spinal cord function in the early stage through surgery combined with hormones and other drugs, prevent further injury to the spinal cord, and promote the recovery of the remaining spinal cord function; at the same time, actively prevent and treat various complications to improve the prognosis of patients and reduce the mortality rate of patients; finally, through active rehabilitation exercise measures, it is helpful to improve the function of paralyzed limbs, improve the quality of life of patients, and some patients can improve their self-care ability.

　　Basic treatment principles for spinal cord injury:

　　1. Proper fixation

　　Prevent secondary injury to the spinal cord due to displacement of the injury site, usually with a jaw-occipital band traction or continuous cranial traction first.

　　2. Methods to reduce spinal cord edema and secondary damage

　　Dexamethasone, 10-20mg intravenous infusion, applied continuously for 5-7 days, then switched to oral administration, 3 times a day, each time 0.75mg, for about 2 weeks.

　　Mannitol, 250ml of 20% mannitol intravenous infusion twice a day, for 5-7 consecutive days.

　　Methylprednisolone Pulse Therapy: 30mg per kilogram of body weight is administered as a single dose, followed by a 15-minute intravenous injection, resting for 45 minutes, and then a continuous intravenous infusion at a dose of 5.4mg (kg/h) for the next 23 hours. This method is only used for those injured within 8 hours.

　　Hyperbaric Oxygen Therapy. According to animal experiments, hyperbaric oxygen therapy is most effective within 2 hours after injury, which is obviously not suitable for clinical cases. According to experimental experience, good results can also be achieved within 4-6 hours after injury.

　　3. Surgical Treatment

　　Surgery can only relieve the compression on the spinal cord and restore the stability of the spine, but cannot restore the function of the damaged spinal cord. The approach and method of surgery depend on the type of fracture and the location of the compressive object.

　　The indications for surgery are:

　　1) Vertebral fracture, dislocation involving the articular process locking:

　　2) Satisfactory reduction of spinal fracture or the presence of unstable factors in the spine:

　　3) Radiographic evidence of bone fragments protruding into the spinal canal and compressing the spinal cord:

　　4) The level of paraplegia is continuously rising, indicating active bleeding within the spinal canal. MRI shows that bleeding within the spinal cord can be surgically opened from the posterior midline to the central sulcus, removing blood clots and effusions, which is conducive to the subsidence of edema. The outcome after surgery is difficult to predict year by year, generally speaking, the paraplegia index is expected to improve at least one level after surgery. For complete paraplegia, improving one level does not solve many problems, while for incomplete paraplegia, improving one level means a possible improvement in the quality of life.